by Kaplan Nursing | March 30, 2023
The National Council of State Boards of Nursing (NCSBN) is launching a new and improved NCLEX® exam called the Next Generation NCLEX-RN® examination (NGN) in 2023. The NGN, also called the Next Gen NCLEX®, is not a complete overhaul of the NCLEX®; however, it will feature some significant changes. As we approach the launch of the Next Generation NCLEX®, Kaplan understands that nursing educators need increased support and innovative resources to prepare their students for the rigors of the exam. In the following article, we outline what you need to know about the NGN and offer resources to help you guide your nursing students to success.
[Read next: Virtual Simulation: Free Resources for Nursing Educators]
How is the NCLEX® Changing?
Kaplan experts met with the NCSBN to learn more about the Next Gen NCLEX® and walked away with several pieces of new information about the pending test changes. Here are five things to know about the NGN:
1. New NGN Item Types
The test will consist of new NGN items plus current NCLEX®-style items. Five item types have been approved for the NGN: Extended Drag & Drop, Matrix, Cloze, Highlight, Select All That Apply (SATA).
2. New NGN Question Formats
New items will be presented on a split-screen: the case on the left and the question items on the right. An Electronic Health Record will contain both relevant and irrelevant information. More information tabs may be added as the case progresses.
3. NGN Clinical Judgment Item Updates
Every case scenario will have six items associated with the case, and each test will contain 2-5 cases or item sets, resulting in 12-30 clinical judgment items per test. The name of the former clinical judgment task model has been changed to NCSBN Clinical Judgment Measurement Model.
4. Matrix Item Answers
Matrix items may have either one possible answer or more than one possible answer, which will be indicated by the style of the selection buttons next to answer choices: circles indicate only one possible answer, whereas squares indicate there is more than one possible answer.
5. Changes to the NCLEX-RN® and NCLEX-PN®
Both the NCLEX-RN® and NCLEX-PN® are changing and will have the Clinical Judgment Measurement Model applied to practice with case studies that focus specifically on clinical judgment. While there are elements of clinical decision-making in the PN nursing process, the NCLEX-PN® questions will not use hypotheses or prioritization as often since they are not reflected in the scope of PN practice.
Free NGN Practice Questions
Experience the new item types on the Next Gen NCLEX with our newly-released practice questions. Below, you can read and watch webinars about each new item type on the NGN. If you’re ready to get a feel for the exam and work through items on your own, try our free practice questions for the Next Gen NCLEX.
Frequently Asked Questions about the Next Generation NCLEX®
Below, we address some frequently asked questions about the Next Generation NCLEX®.
When will the Next Generation NCLEX® start?
The Next Generation NCLEX® is scheduled to launch in April 2023.
Will the Next Generation NCLEX® still be a Computer Adaptive Test?
Yes, the Next Generation NCLEX® will continue to use computer adaptive testing (CAT).
Is the Next Gen NCLEX® harder than the NCLEX®?
The Next Gen NCLEX® will feature more in-depth questions to thoroughly test nursing students’ readiness to enter the field. Some questions will include unfolding case studies intended to take students to the bedside.
Is NCLEX® changing in 2022?
No, the NCLEX® will not be transitioning to the Next Generation NCLEX® until April 2023.
Building Student Clinical Judgment Skills for the Next Generation NCLEX®
Research suggests that strengthening clinical judgment skills can remedy a majority of mistakes made by novice nurses. Therefore, it is the responsibility of nursing educators to provide students with the comprehensive tools they will need to succeed on the NGN as well as provide safe, effective, and competent care when they enter the workforce.
In the Kaplan Nursing white paper, “Building Student Clinical Judgment Skills for the Next Generation NCLEX,” Shannon Meijer DNP, RN, Kaplan Nurse Consultant, takes a deep dive into the ways in which educators can and must help their students build strong critical thinking, clinical reasoning, and clinical judgment skills.
DOWNLOAD "Building Student Clinical Judgment Skills for the Next Generation NCLEX" to read the white paper.
The white paper offers detailed information and analysis about:
- Defining the function and importance of critical thinking, clinical reasoning, and clinical judgment for success on the Next Generation NCLEX® and beyond
- Preparing students to confidently make higher cognitive-level decisions in advance of what they will be examined on for NGN
- Exploring traditional as well as outside-of-the-box methods for providing students with opportunities to practice and build on these skills
- Examining the importance of evaluating students’ critical thinking, clinical reasoning, and clinical judgment skills
- Enhancing student comprehension, retention, and ultimate ability to provide competent patient care through virtual simulations, such as i-Human Patients
What Changes to the NCLEX® Mean for Nurse Educators
Early research from NCSBN indicates that while educators believe they are teaching the nursing process in an iterative format, candidates tend to use the nursing process in a linear way; meaning that students come to one hypothesis and run through the entire nursing process (including evaluation) before looking at another hypothesis.
Good news—Kaplan's proven test prep methodologies align with the new Measurement Model, including a focus on developing clinical reasoning through various hypotheses and potential outcomes as part of our Decision Tree. Our critical thinking model prepares students with the skills necessary to demonstrate competent clinical judgment on test day.
On NGN, it will be important for your students to be familiar with Electronic Health Records. You can offer students additional opportunities to master clinical judgment skills and get comfortable with Electronic Health Records in a safe, standardized, and virtual clinical setting with i-Human Patients by Kaplan. The i-Human Patients by Kaplan decision-making model was designed to be aligned with NGN; it prepares students to think like nurses by putting the student at the bedside of the patient and allows educators to measure clinical competency. To learn more about i-Human Patients virtual simulation, request a demo.
Next Generation NCLEX® Item Writing
In today’s rapidly changing world, nurses need to be able to collect and synthesize information and formulate and test hypotheses in a matter of moments. These skills can collectively be called higher-level cognitive reasoning and reflect the nurse’s ability to make clinical judgments. This need to enhance and test nurses' clinical judgment and critical thinking skills has led the NCSBN, the makers of the NCLEX® licensing exams, to create a new class of test items called Next Generation NCLEX® (NGN) test items.
NGN test items are designed to test higher-level cognitive thinking skills of future nurses and are meant to bridge the gap between preparedness for and successful completion of the NCLEX® and on-the-job performance for nurses. Nurses must be prepared for their important role in healthcare in a manner that is more profound than simply knowing how to recite facts or protocols.
The NCLEX® strives to be a reflective assessment of nursing clinical judgments, therefore, the NGN items are built upon a rich theoretical and psychometric framework. The NCSBN Clinical Judgment Measurement Model, based on several years of study of the skills essential to nursing, provides a mental model and framework in order to establish a foundation in which other models (e.g., relating to assessment) could be advanced.
While the NGN items are not expected to debut in the NCLEX® until at least April 2023, the NCSBN is taking steps to create new test items that align to the NGN standard. By doing so, the desired outcome is an improvement in the NCLEX®’s ability to test higher-order cognitive skills, which would be useful in a hospital setting.
Six Steps to Effective Next Generation NCLEX® Item Writing
Writing effective NGN items can help test essential higher-level cognitive skills, which are required for effective nursing clinical judgments. In this way, NGN items can help identify nursing students who understand the nursing curriculum and have developed the proper analytical skills through their training.
1. Determine the objective you wish to test
Before you write an NGN item, determine the test objective. The test item objectives are typically based on nursing curriculum objectives. Ideally, the objective focuses on one task, skill, or concept that the student has learned.
Keep in mind that the different levels of Bloom’s taxonomy―from remembering concepts to synthesizing and creating new work―will need to be considered in this objective. NGN test items are focused towards the application, analysis, and evaluation of novel information, which places them on the higher end of the taxonomy.
2. Decide which NGN item type to use
The new NGN item types include:
- Cloze (Drop-Down) items: The applicant completes sentences or information in a chart by choosing a word or phrase from a dropdown list.
- Extended Multiple Response items: In this item type, up to 10 options are presented, and only one, more than one, or all may be correct. Before answering this type of question, the applicant may have to read a passage upon which the test item is based.
- Extended Drag-and-Drop items: The applicant uses “drag and drop” to complete a given scenario. For example, the applicant may be presented with several different steps involved in treating a given condition. The applicant would then drag and drop the steps into the proper order for treatment. Other types of “drag and drop” questions could involve sorting different types of patients who may require private rooms or to “drag and drop” the correct words to complete a sentence. Unlike current NCLEX® test items, the Extended Drag-and-Drop items may not require that all options be used when completing a given scenario.
- Enhanced Hot Spot (Highlighting) items: In this item type, the applicant is asked to highlight concerning findings that require follow-up by the nurse or health care provider.
- Matrix/Grid items: In Matrix/Grid items, the applicant assigns a value to a group of responses. For example, the applicant may be asked to decide whether a given action is indicated, non-essential, or contraindicated.
- Bow-tie items: To complete the bow-tie item, all targets (placeholders for response options) must be filled with a token (the response option), which are found directly below the bow-tie display in labeled columns. Tokens from the same column are interchangeable, but a token from an “Actions to Take” column cannot be used to fill a “Parameter to Monitor” target and vice versa.
- Stand Alone Trend items: These are individual items that require the entry-level nurse to review information gathered over a period of time. Trend items address multiple steps of Layer 3 of the NCJMM, but do not follow the six-item sequence like case studies do.
3. Write the stem
The question stem is the part of the question that prompts the student to select the correct answer or perform other tasks necessary to provide an answer (such as drag-and-drop items in a “drag-and-drop” question). The stem should be written based on the test objective and should have relevant information needed to formulate a response.
4. Write the answer
The next step in writing an NGN item is to write a good correct answer. The ideal answer should not be confusing or unclear and should be easy to pick out from the list of answers with the relevant knowledge base.
5. Write a few distractors
Distractors are incorrect answers that are written which, though wrong, can probe the student’s knowledge and reasoning skills. Distractors can be a predictable error, a common misconception, a clinical error, or a common mistake that might occur in a hospital setting.
Distractors should be realistic and well-written. The wording of distractors is important, and they must be phrased clearly and unambiguously in order to be best able to illuminate deficiencies in learning rather than to trick the student into choosing a wrong answer.
6. Ask yourself whether your test question meets NGN standards
These test items should answer the following questions essential to on-the-job, higher-level cognitive thinking processes predictive of success in nursing:
- Can students recognize clinical cues? In other words, can they identify the most important information?
- Can students analyze cues? In other words, can they distinguish the most important information?
- Can students prioritize hypotheses? That is, can they synthesize important information to determine client needs?
- Can students generate solutions or develop possible care options that align with client needs?
- Can students identify and perform the appropriate clinical actions?
- Can students evaluate outcomes and determine the effectiveness of interventions they have deemed appropriate?
Writing NGN-style items requires a combination of patience, skill, and practice; therefore, knowing the purpose of NGN items is crucial. An effective NGN-style item will gauge and reliably test a students ability to make safe, effective clinical decisions. When writing NGN-style items, validate both the content and the appropriateness of the item to test entry-level preparedness for nursing. Know the job your NGN-style item is being tasked with performing. Meaning, is the purpose of the NGN-style item to gauge the student’s ability to identify relevant information that requires further probing and investigation by the nurse (i.e., recognizing and analyzing cues), or is the purpose of the NGN-style item to determine whether the student’s actions met the client’s needs (i.e., evaluating outcomes)?
Creating Next Generation NCLEX® Test Items
In the Kaplan Nursing white paper, “Creating Next Generation NCLEX® Test Items to Ensure the Success of the Nursing Workforce,” Ryan Goble, MSN, RN, CEN, CPEN, Senior Content & Curriculum Manager, Kaplan Nursing, takes a deep dive into the theory and practice of creating test items that not only prepare students for the exam but also hone their overall nursing clinical judgment skills.
DOWNLOAD "Creating Next Generation NCLEX® Test Items to Ensure the Success of the Nursing Workforce" to read the white paper.
The white paper offers detailed information and analysis about:
- Factors that contribute to and improve nursing clinical judgment (NCJ)
- The importance of higher-level cognitive functions in NCJ
- How Kaplan is preparing for NGN
- New NGN item types and methodology for effective writing of NGN items
- ...and much more.
NGN Bow-Ties & Trends
The NGN has introduced new item types, which are answered based on the information you receive in Case Studies. This information is presented in the form of medical record tabs. There are 6-question sets that progress, asking you to recognize and analyze findings, make clinical judgments to provide appropriate care, and evaluate the client's response. There are also two standalone item types, the bow-tie and the trend. Both standalones also use the information provided in a client's Case Study.
The bow-tie item is really three drag and drops with three answer wells. In order to answer the bow-tie, you must be able to use all of the cognitive skills needed for clinical judgment. First, you will recognize, analyze and prioritize information to determine what condition is being described. Then, you will decide which nursing actions you should take to address that condition. Finally, you will select the parameters you will need to monitor for a client with that condition.
The center drag and drop is the condition. You select one response from the answer well and pull it into the correct space. You select two responses from the answer well of nursing actions on the left and two responses from the answer well of parameters to monitor on the right. The result? A diagram that looks like a BOW-TIE!
The key to the trend item is that the information in the medical record tabs is trended over time. For example, vital signs may be improving or worsening, or lab results may indicate a worsening or improving condition. You will need to analyze that trend to determine what is happening and what the nurse should do in response. The trend item can use any of the new NGN item types except for the bow-tie. So a trend item can be a single highlight, cloze, matrix, rationale, or extended multiple response item. You could just be recognizing the trend or generating a solution because of what the trend means for the client.
How to Write a Next Generation NCLEX® Case Study
The new question types on the Next Gen NCLEX® will include case study information. The NGN case study is designed to provide data for the student to utilize in applying the clinical judgment measurement model. The model identifies six cognitive processes a nursing graduate must master. These include recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes. Nursing students must practice mastering the cognitive processes in question format before taking the high stakes NCLEX® examination. The Kaplan experts have many resources available to assist educators in helping their nursing students to be successful. Below, we provide you with easy steps to transform your nursing experience into a case study for new graduates.
1. Determine the goal of the NGN case study
What is the goal of the case study? Do you want to teach a specific concept, a disease process, or appropriate interventions for a clinical situation? Remember, all case studies should be leveled to the new graduate. Try hard not to include lessons learned from years of clinical nursing practice. We need nursing students to provide safe, quality care equal to the entry-level nurse competencies.
2. Tell a clinical story
Don’t worry about the specific questions you intend to develop. Think about a patient you may have cared for while performing bedside nursing. We all have those patients that have impacted our lives and our nursing careers. Use that story to bring the case alive for the student. Put the student at the bedside.
3. Consider the process of recognizing cues
Once you have a story, consider the first cognitive process of recognizing cues. What are the most pertinent clinical findings, objective and subjective, necessary for the nurse to identify? These findings can include vital signs, clinical signs the healthcare provider can observe, symptoms the patient describes, or observations by family members. This information forms the basis for the selection of findings that need follow-up by the nurse.
4. Consider the process of analyzing critical information
Once the nurse identifies the pertinent cues, they need to interpret the information. For example, does the presence of fever indicate a disease process? Is the shortness of breath a pulmonary issue or a cardiac problem? The nurse will apply the clinical manifestations to what is known about the patient, thus analyzing the cues.
5. Prioritize hypotheses
The next step is to prioritize hypotheses. What is the problem or problems the patient is experiencing? Which one is most important for the nurse to address first? For example, the patient has shortness of breath and foot pain from stubbing their toe on the curb leading to the Emergency Department. A simple example but one which requires the nurse to make a decision.
6. Generate solutions
Now what? Generate solutions. What actions can the nurse do to assist this patient? Does the patient need oxygen, medications, diagnostic tests, or immediate intervention by a physician? In this question, the nurse will select from essential interventions needed, actions that can wait until later, or actions that will cause more harm to the patient and need to be avoided. Consider the story; what were the choices you had when you were caring for this patient in real life?
7. Take action!
Assessments are done and decisions are made; now is the time to intervene for the patient’s benefit. The questions you develop for this step can include selecting appropriate actions, identifying how to perform specific interventions, or even the need for additional assessment.
8. Ask yourself, "did it work?"
The final phase is to ask, "did it work?" Is the patient better or worse? How do you know? What clinical findings support that decision? The cognitive process encompasses evaluating outcomes—the last but often the most crucial step in the case study process.
You did it – you have designed an NGN case study! Maybe you don’t have the technology available in your testing system to deliver the questions in the manner that NCLEX® questions will be delivered in 2023, but that is okay for now. Giving students a head start on thinking through the case study is valuable for their clinical judgment development and success in the future.
References
National Council of State Boards of Nursing (NCSBN). (2020). Next generation NCLEX news:The NGN case study. https://www.ncsbn.org/NGN_Spring20_Eng_02.pdf.
Free Downloadable Next Generation NCLEX® Resources
- DOWNLOAD "Building Student Clinical Judgment Skills for the Next Generation NCLEX" to read the white paper.
- DOWNLOAD "Creating Next Generation NCLEX® Test Items to Ensure the Success of the Nursing Workforce" to read the white paper.
- DOWNLOADyour complimentary copy of Kaplan’s Next Generation NCLEX: What You Need to Know, Spring 2021 Edition e-Book for even more information about NGN test updates, tips for success, and more.
Article Contributors
- Shannon Meijer DNP, RN, Nurse Educator Consultant
- Christi Doherty, DNP, MSN, RNC-OB, CNE, CHSE, CDP, Director, Nursing Research
- Susan Sanders, DNP, RN, NEA-BC, Vice President of Kaplan Nursing
- Jennifer Allen, MS, RN, ACNP-BC
- Rebecca L. Potter PhD(c), MSIDT, MSN/ED, RN, Director of Nursing Product Content
- Susie Compton, RN, MSN, Kaplan Content Manager
NCLEX® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names are the property of the respective trademark holders, none of whom endorse or are affiliated with Kaplan.
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